A changing perspective: Improving access to fertility preservation

Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco School of Medicine, 94143, USA.
Nature Reviews Clinical Oncology (Impact Factor: 14.18). 01/2011; 8(1):56-60. DOI: 10.1038/nrclinonc.2010.133
Source: PubMed


Approximately 120,000 young women are diagnosed with cancer every year in the USA. Many will have treatment that can reduce their fertility, although few will learn this fact before their treatment commences. This presents a tremendous quality of life issue post-treatment, as evidenced in this Perspectives by a personal account from a 23-year-old woman diagnosed with breast cancer. Clinicians must increase awareness about patients' desires for motherhood and awareness about their individual reproductive potential. We demonstrate novel evidence about the wide variability in ovarian reserve in women of similar age, using assessment by antral follicle count. We show how a unified approach between oncology and fertility teams can help patients better understand their risk of treatment-related infertility, as well as how to take effective measures to mitigate it. Finally, we present options for fertility preservation, based on the time point at which consultation occurs.

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Available from: Joseph Letourneau, Apr 05, 2015
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    • "However, chemoradiotherapy to ablate the bone marrow and prevent rejection is gonadotoxic (Sanders et al., 1988); in one retrospective study, only 0.6% of patients successfully conceived after SCT (Salooja et al., 2001). Ideally, patients should be referred to a fertility preservation specialist before gonadotoxic treatment (Letourneau et al., 2011). "
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    ABSTRACT: A 19-year-old thalassemic woman had tissue from one of her ovaries cryopreserved prior to bone marrow transplantation, total body irradiation and sterilizing chemotherapy. As expected, premature ovarian failure resulted from this treatment. Transplantation of her thawed ovarian tissue resulted in return of menstrual cycling and the patient then underwent several IVF cycles. The patient, however, had poor ovarian response to hyperstimulation. We thus considered an alternative approach based on the observation that very thin ovarian fragments that preserve the basic ovarian structure [ovarian micro-organs (MOs)] induce angiogenesis and remained viable after autologous transplantation in animals. We report that preparation of autologous tiny ovarian fragments (MO)s and reimplantation into our patient resulted in IVF pregnancy and delivery of a healthy baby.
    Human Reproduction 03/2011; 26(5):1097-103. DOI:10.1093/humrep/der063 · 4.57 Impact Factor
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    ABSTRACT: Infertility is often an expected side effect of cancer treatment, although the idea of fertility and sterility may be difficult for the child or adolescent patient to comprehend. Several established fertility preservation options exist for males and females, such as cryopreservation of sperm or embryos. Experimental therapies, which require institutional review board approval, are also being tested. While the science of fertility preservation for adolescents with cancer is advancing, the social science research in this area is lacking. Specifically, there are only a small number of studies about the psychological reproductive concerns in the pediatric oncology population. These studies have provided groundbreaking information for future research, but also illustrate the challenges in conducting research in this area. This article comments on those challenges and, when possible, presents solutions for confronting them.
    04/2011; 1(1):31-35. DOI:10.1089/jayao.2010.0003

  • The Lancet 02/2012; 379(9815):495-6. DOI:10.1016/S0140-6736(11)61814-X · 45.22 Impact Factor
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